Doctors fear hospital ‘holding areas’ will make overcrowding worse

Doctors say a plan to set up new “holding areas” for ambulance patients queued outside Victorian hospitals might not fix overcrowding, but could make the problem worse.

The Age has seen memo reportedly sent to hospitals across the state describing a plan to establish spaces capable of holding up to 10 patients, in some cases outside emergency departments, at times when their cubicles are full.

A tent set up outside the Sunshine Hospital emergency department in October 2021.Credit:Jason South

The aim is to prevent paramedic crews getting stuck at hospitals waiting to hand over their patients, for many hours, or in some cases, for their entire shift. The growing problem has contributed to flagging ambulance response times, now more than 20 per cent below target for the most urgent cases.

The memo said the holding areas would be for patients who require treatment within a timeframe of 30 minutes to two hours, categorised from urgent to non-urgent. They would be patients who could be looked after by a range of different staff, from registered nurses to student paramedics.

A Victorian government spokeswoman said the “Ambulance Victoria Offload” model was now operating at 14 Victorian public hospitals, allowing patients to be monitored and submit for tests while waiting for admission to the emergency department or a ward. Some hospitals already have similar arrangements in place.

“This expansion is being closely monitored, and we’ll continue to work with Ambulance Victoria and health services on next steps, including any improvement opportunities,” the spokeswoman said.

Dr Belinda Hibble is concerned not enough is being done to address the cause of hospital overcrowding.

However, the plan has “generated deep concern” among members of the Australasian College for Emergency Medicine, who say it is simply creating another queue where patients might deteriorate.

The Victorian chair of the college, Dr Belinda Hibble, wrote to state Health Minister Mary-Anne Thomas this week, warning that hospitals which already had these types of “holding areas” – sometimes in marquees or other temporary structures – were reporting “frequent episodes of compromised patient care”.

Hibble told The Age that amid an ongoing and chronic shortage of healthcare staff, it would be better to increase the number of workers on wards inside hospitals to free up space to move patients from clogged emergency departments. She said offload areas “risk concentrating resources at the front door”.

“Whenever a system is very clogged and overcrowded all the parts within that system work less efficiently than they would usually,” Hibble said.

Ambulances “ramped” outside Royal Melbourne Hospital in May.Credit:Nine News

Australian Medical Association Victoria board member Simon Judkins said the marquees and temporary structures used outside EDs last year for COVID-19 patients were only meant to be a temporary, crisis measure. Now, some of those had become offload areas.

Whenever a system is very clogged and overcrowded all the parts within that system work less efficiently than they would usually.

Although he acknowledged it was essential to get ambulances back on the road, Judkins said it needed to be recognised that emergency departments were not the root of the problem. For example, some of the ambulances left waiting, queued outside hospitals recently were occupied by people who could easily have received care from their GP, or in the community with disability support.

He has previously suggested other areas of hospitals could also be used to accommodate emergency patients at peak times. In some instances, emergency departments are so busy patients do not even make it to a cubical, but receive their treatment in waiting rooms.

“Why can’t we take a perfectly stable patient who’s waiting for an operation on their ankle and sit them in a waiting area up on the ward?,” Judkins asked.

“In a crisis you’ve got to do things differently, and we’re not doing those things.”

Victorian Ambulance Union secretary Danny Hill said offload areas could be the best of a number of the bad options for the time being.

“I don’t think anyone, including [Ambulance Victoria] would advocate that this is a permanent fixture, I don’t think anyone wants to see that at all, it’s [for] while you have such high demand.”

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